Laboratory Medicine Updates - 12/7/2001

University of
Virginia Health System

Medical
Laboratories

“Quality You Expect, Service You
Deserve”

LABORATORY MEDICINE
UPDATE

December 7, 2001

CHANGES IN SAMPLE REQUIREMENTS

VAP
Testing: Our referral laboratory for VAP testing is
changing their requirements to serum as the specimen of choice.
Please draw a minimum of 1 full red-top tube or two
gold-top serum separator tubes.

Hepatitis B Quantitative
DNA: With an expanded range for this analysis (now reporting to
1,700,000,000 copies/mL), our referral laboratory now requires a
minimum of 1.5 mL serum. Please draw a full red-top tube or two
gold-top Serum Separator Tubes to assure adequate volume.

METHADONE SCREENING

The Toxicology Laboratory will perform specific
methadone screening and confirmation upon request. In order for the
laboratory to provide a prompt result, please order METHADONE at the
same time as the Urine Drugs of Abuse Screen is ordered. As with all
drugs of abuse testing, screen positive results will be confirmed by
mass-spectrometry. The charge for methadone screening (with
confirmation) is $22.00.

TRANSPORTATION OF LEUKEN TRAP
TUBES

Please do not use the Pneumatic Tube System for
the transportation of samples to the laboratory when specimens are
collected in LEUKEN TRAP tubes. Phone the Resource Support Center at
2-1600 for pickup from the unit or clinic.

Samples sent through the tube system have leaked,
contaminating the bag and in some cases the entire system, requiring
downtime for contamination.

PROTOCOL FOR PERCUTANEOUSLY DRAWN BLOOD
CULTURES

Based on a study conducted at the University of
Virginia in 1999-2000 comparing four common antiseptics, a phlebotomy
protocol for percutaneously drawn blood cultures has been recently
approved by the Infection Control Committee and Medical Policy Council.
The study demonstrated that isopropyl alcohol was efficacious and cost
effective, and had a lower incidence of cutaneous reactions than other
antiseptics. The new policy was implemented on November 1, 2001; a copy
of the protocol follows.

2. Select the site of venipuncture. If the patient
is unusually dirty, wash the intended site with soap and water prior to
venipuncture.

3. Put on exam glove.

4. Open a packet containing an isopropyl
alcohol-saturated pad.

5. Scrub the venipuncture site gently but firmly
with the pad beginning in the center and continuing in an outward
direction using circular strokes for an area of 2 to 3 inches in
diameter.

6. Repeat this procedure twice using two more
alcohol pads.

7. Allow the area to dry completely after the
third alcohol pad. Even if the area appears to dry sooner, wait at
least 1 full minutes before performing venipuncture.

8. Prepare the culture bottles for inoculation and
wipe the tops with a sterile alcohol pad.

9. Apply a tourniquet, being careful not to touch
the prepped area with gloves or tourniquet.

10. Perform phlebotomy using the needle and
syringe (20 mL of blood per set of cultures, i.e., 10 mL per bottle, is
recommended for adult patients).

11. Release the tourniquet and withdraw the needle
extending the protective sheath into the locked position after
withdrawal of the needle. Apply pressure to the site of venipunture and
place a bandage over the puncture site.

12. Remove the sheathed safety needle from the
syringe. Attach a new needle to the syringes and inoculate the blood
culture bottles. Sheath the needle after inoculating the cultures
bottles. NOTE: If blood sample is drawn at the time of placement of a
new intravascular catheter or at the initiation of hemodialysis through
a graft or fistula, prep the skin as described above and draw the
sample through the catheter into a syringe. Using aseptic technique,
place a sterile needle on the syringes and inoculate the culture
bottles.

13. Dispose of the sheathed needle(s) and syringe
in the appropriate sharps container.

14. Label blood culture bottles and send samples
to the lab using the standard protocol for specimen submittal.